Topic 8: Core Beliefs & Behavioral Exposure {by 11/4}

[Core Beliefs] – Watch MDD-16: Core Beliefs – Identifying 2 – Core Belief Flowchart-Part A.  Answer the following: (1) In what way was the CBF-A effective in understanding how the clients’ core belief developed? (2) What additional historical information could have been obtained to understand the development of the client’s core belief?

 

[Core Beliefs] – Watch MDD-17: Core Beliefs – Modifying – Evidence and Advantages/Disadvantages -AND- Modifying 2 – Core Belief Flowchart-Part B.  Answer the following: (1) What information or themes obtained from both techniques will be helpful in developing a new core belief? (2) What could be a possible new (positive/realistic) core belief to test with the Core Belief Flowchart (Part B) and a Behavioral Experiment?

 

*We will watch “MDD-18: MDD-18: Core Beliefs – Modifying 3 – Behavioral Experiment” in Class.

 

[Behavioral Exposure] – There is one reading due this week (Volungis – 1 Chapter).  (Judy Beck neglects behavioral exposure in her book.)  For this discussion, share at least two main thoughts: (1) Why is behavioral exposure very effective for certain disorders/types of distress?  (2) What are some cautions to consider when implementing behavioral exposure interventions?

 

Your original post should be posted by the beginning of class 11/4.  Have your two replies posted no later than 11/6.  *Please remember to click the “reply” button when posting a reply.  This makes it easier for the reader to follow the blog postings.

31 Comments (+add yours?)

  1. Jennifer Vear
    Nov 02, 2021 @ 11:27:47

    [Core Beliefs] – MDD-16

    1. The CBF-A is a great tool to understanding how a clients’ core belief has developed. By starting off some historical information, it can allow the client to look back in their life to see other areas where they felt that core belief was true for them. The therapist will coach them through determining if there was one significant person or event in their life that spurred these thoughts to begin with. The therapist and client can also gauge some other factors such as various stressors, coping strategies, and other aspects that could have influenced the development of the core belief. Once you are able to see where it could have begun, the therapist can then help the client figure out how to start making changes. That could include processing through some past traumas or experiences, working on more effective coping strategies that could help that could either be emotion-focused or problem-focused depending on the situation. Then finally, getting two main events to focus on and determining the clients’ thoughts, emotions, and behaviors in these situations can help them to see and understand where their belief came from. This is also helpful to then look back on once the client has worked on a more positive core belief for Part B. Overall, this exercise allows the therapist to help the client break down parts of their life that have contributed to them developing their core belief, and therefore, will help them work toward changing it for the better.

    2. Additional historical information could be obtained in order to understand a client’s core belief. Family history, for example, could be an interesting factor that could influence how an individual copes with stressors or even lead to the reasons for significant distress. Also, I believe that it does not always have to be the significant life events or people that can influence the creation of a negative core belief. It could also be persistent and continuous minor events/experiences/people that have led the individual to feel a certain way. This historical information could help the client and the therapist to see aspects that are not so clear-cut, but also helped the individual in producing this negative core belief.

    [Core Beliefs] – MDD 17

    1. Looking at the advantages and disadvantages of an old core belief, as well as hypothesizing more positive automatic thoughts on a particular event can help someone to develop a more positive core belief. Mark could clearly see the disadvantages of having his “old” core belief. He could tell that it was preventing him from trying new things, making new friends, and having an effect on his personal view of himself. The advantages of that “old” core belief were a bit more difficult for him, but it was used as a way of helping him realize why he might put up a mental block or prevent himself from pursuing friendships because it saved him from getting hurt. However, by analyzing this evidence, it could also help him hypothesize a “new” and more positive core belief that could be more beneficial for him. Furthermore, when he looked at the events and automatic thoughts from Flow Chart A, he had to try and come up with more realistic and positive automatic thoughts that could have been a reason as to why his coworker did not invite him out. All of these techniques combined, helped Mark to develop his “new” core belief that he is a generally liked person.

    2. A more positive and realistic core belief for Mark would be that he is a generally liked person. This will allow Mark to take a new perspective on how he is not completely unlikeable, as there is evidence out there that proves so, such as previous friendships and his own girlfriend. The more that he looks at various situations through this type of lens, the more he will be able to see the positive side and not take things too personally. He was also able to look at the advantages of this new core belief, and see that if he thought more like this, he would be able to put himself out there more often, not take things so personally, and be able to make more friends. This new core belief would also be great for him to try a behavioral experiment, as he would be able to try and think more positively and as an experiment, possibly attempt to engage in more conversations with coworkers and maybe even ask someone new to lunch or plan out an evening in advance with some friends. If someone were to say no that day, then instead of giving up, he could suggest another, more concrete date that would give the person time to plan and consider as well.

    [Behavioral Exposure]

    1. Behavioral exposure can be very beneficial for certain types of diagnoses/types of distress. For example, behavioral exposure can help individuals who feel anxious or have anxiety disorders. With anxiety comes anxious negative automatic thoughts that can increase and stimulate more negative feelings. These negative thoughts feed the anxiety. As a result of these negative thoughts and feelings, the individual can perform behaviors such as isolation, avoidance, or have a panic attack and become fearful of the prospect of various stimuli, experiences, and events. Behavioral exposure is a way of exposing these individuals in a safe environment and helping them control and modify those thoughts so that they can feel and realize that they will be okay. Their bodily response to the feared stimuli can be altered and recognized as invalid, as the individual is truly safe and will not be harmed or will not die. To do this, the individual can learn coping mechanisms such as breathing exercises and mediation, or they can experience direct exposure in a controlled environment with guidance.

    2. When implementing behavioral exposure interventions, it is important to consider the vulnerability of the client during the exposure. Experiencing behavioral exposure can be very distressing for the client and the therapist needs to be careful how much they expose the client to. If the exposure is not carefully done, it could possibly increase the client’s anxieties/fears/traumas and harm them. If they do not feel safe or listened to, they might not come back or ever pursue therapy again. The therapist needs to listen to the client and their needs. Exposure needs to be a controlled process that is primarily reliant on how ready and willing the client is.

    Reply

  2. Frayah Wilkey
    Nov 02, 2021 @ 11:59:17

    [Core Beliefs] – Part 1
    1. The CBF-A seemed really helpful in getting to the root of Mark’s core beliefs and current state of mind. It encouraged him to discuss some experiences he had in high school and how those thoughts carry through to present day. He even described how old rejections still hurt to talk about, showing how deeply ingrained those events are for Mark. He is able to pinpoint specific individual’s that played a role in the development of his core beliefs, including friends and family. Some interactions with his family cause him to carry certain stressors at work and changed the expectations he puts on himself. He also describes how he reacts to his automatic thoughts, such as withdrawing. Overall, Mark is able to explore multiple core beliefs and what contributed to their development throughout the video.

    2. I think that the video was thorough in exploring Mark’s past and his experiences. An additional piece of historical information that could have been discussed is previous romantic relationships or his first real relationship in or after high school. This would increase the understanding of the development of the client’s core belief by providing additional insight to his perception of being unloveable. I’d be curious about this because Mark doesn’t seem to feel rejected by Melissa very frequently but they do have some problems. I think the core belief could be explored more through this avenue.

    [Core Beliefs] – Part 2
    1. Mark did a great job participating in the CBF-B. He was able to identify several advantages and disadvantages for the core belief and was able to recognize the impact on his life. He realized how things had become cyclical for him and the huge impact his core belief has on his valuable relationship. This seemed to provide motivation for him to shift his thinking and beliefs about himself in order to benefit himself and those in his life. The process of ‘thinking out loud’ also helped him formulate a plan and alternatives on his own.

    2. In the video, Mark developed the alternative belief that he’s a ‘generally likable person’. I think that this will help to reduce his distress and negative feelings towards himself. Another possibility to test using the CBF and behavioral experiment is that he is also worthy of love/a lovable person. Mark seems to feel supported by Melissa but feels lowly of himself in most relationships and I think if he was more confident in the valuable relationships he has, his depressive symptoms would decrease. These relationships could include Melissa and family members because he mentioned previously that they are still close. This goes deeper than being likable and would target the relationships that he’s had for the longest. He could apply similar behavioral experiment methods to test this.

    Reply

    • Frayah Wilkey
      Nov 02, 2021 @ 12:07:32

      [Behavioral Exposure]
      1. Behavioral exposure is useful for certain disorders, such as anxiety disorders and PTSD. It targets avoidance behaviors and can help reduce the distress over time by allowing the client to take small steps in a safe environment. This will reorient their thoughts and reactions to the stressor(s) and can provide the client with evidence that they will be okay after experiencing the exposure.

      2. The clinician should be cautious when planning and implementing behavioral exposure interventions. They should consider the progress of the client and if they are ready first and foremost to avoid and regression. They should also consider the types of exposure that will be used and plan the steps accordingly. Some clients/stressors may need greater time spent between exposures.

      Reply

    • Jennifer Vear
      Nov 03, 2021 @ 15:29:33

      Hi Frayah!

      In the first section, you make a really great point about how Mark does not feel his core belief applies to his relationship with Melissa. As you mentioned, they do have some issues, I would also like to see how much this core belief impacts that relationship. I am curious if he does anything when they are together or if they argue that could make him feel this way, or if it is primarily with others. Overall, great job!

      – Jenn

      Reply

    • Kaitlyn Tonkin
      Nov 06, 2021 @ 12:20:45

      Hi Frayah!

      I really liked how you mentioned exploring Mark’s past romantic relationships might be useful in understanding his core belief as well. In the videos, Mark talks about friendships he has had in the past which contribute to his core belief, but he never discusses any type of romantic relationship so I think it might be important to explore that too!

      Great job!

      -Kaitlyn

      Reply

  3. Kaitlyn Tonkin
    Nov 03, 2021 @ 16:26:47

    [Core Beliefs] – Part 1

    1. The core belief flowchart was helpful for the client to figure out how his core belief developed because it allowed him to take a look at his past experiences with friends and realize how similar those are to things he experiences currently in life. The flowchart is helpful because it focuses on certain areas of life rather than just asking the client to give a summary of their history. It allows clinicians to pinpoint certain areas that aid in developing core beliefs. In this particular example, Mark was able to talk about experiences with friends in high school and college where they stopped talking to him and those were the first times he remembers feeling unlikeable. Mark also discussed current feelings of being not good enough or feeling unliked. The core belief flowchart is also useful because it gets at the clients’ feelings about themselves as well. In the example with Mark, he was asked about certain things he likes about himself, talents and interests he has, and accomplishments throughout his life. The way that the client answers these types of questions can also give answers to the development of core beliefs, which I think is true in Mark’s case here.

    2. Throughout the first part of the core belief flowchart, Mark and his therapist discussed events that occurred in high school and college, as well as later in life after graduating. I wonder if there could be something that happened in Mark’s childhood or adolescence that he might be repressing that could have influenced the development of his core belief that he is unlikeable. I also wonder if there are people in his family who have gone through something similar or had mental health issues themselves. This information may have been obtained during the intake interview and was not relevant and that’s why it didn’t come up here, but if that’s not the case, I think it might be interesting to explore that too.

    [Core Beliefs] – Part 2

    1. Throughout doing the core belief flowchart, both Part A and B, I think that Mark utilized many techniques and discussed things that could be helpful in developing a new core belief. Like negative automatic thoughts, I feel like examining the evidence has always been a good technique for Mark and allows him to put things into perspective. Examining the evidence in terms of core beliefs allowed Mark to see that his friends do hang out with him and invite him to do things so he isn’t unlikeable and people want to spend time with him. Moreover, he has been in a committed, long-term relationship with his girlfriend for a while now, which I think also helps him to understand that he is likeable and even loveable. Another technique that seemed to work well for Mark was talking with his therapist and thinking of more adaptive automatic thoughts. These also allowed Mark to think about things from a different perspective and work towards developing a more adaptive core belief as well.

    2. Through using the core belief flowchart, Mark was able to develop a “new” core belief that he is “generally a likeable person”. I think this is a great core belief for Mark to begin with and work towards developing more adaptive automatic thoughts to go along with it. As discussed in the video, Mark said he could put himself out there more and take initiative when talking with his friends as a way to test this new core belief. Mark could also try to plan a get-together with his friends and their significant others or ask his colleagues at work to go out for lunch one day. If his friends aren’t available to participate in one of these activities, it is important that Mark remembers to think about other reasons why they couldn’t make it instead of it being because he is not likeable. If Mark begins to get overwhelmed and starts to withdraw from those around him, perhaps he could practice a behavioral exposure that wasn’t as daunting, like making conversation with friends or going out on a date with his girlfriend. These activities are still helpful for Mark to see that others want to spend time with him, but they do not require as much commitment from others who have other things to attend to in their lives. Overall, I think that Mark’s new core belief is a great start at diminishing his depressive symptoms and feeling like he is liked by those he interacts with.

    [Behavioral Exposure]

    1. Behavioral exposure can be very effective for certain disorders like anxiety disorders. This is because, with anxiety disorders and distress related to anxiety, individuals often avoid the situation causing them anxiety and do not confront it. Furthermore, these individuals often use coping skills that reinforce their avoidant behaviors which makes it even harder for them to confront the issue. Behavioral exposure works to have the client directly confront their feared situation. Behavioral exposure is most useful when done in vivo, but imaginal exposure is also effective in helping clients who have anxiety disorders or anxiety-related distress confront their fears. Behavioral exposure is also effective because it is done in such a way that the client feels safe and has their therapist there to give them emotional support without being a problematic source of support. As we have learned throughout this course, thoughts, emotions, and behaviors are all connected to one another. Behavioral exposure allows for clients to change their behaviors and modify their thoughts at the same time, again in a safe environment with a source of stable emotional support – i.e. their therapist.

    2. When implementing behavioral exposure interventions, it is important to take caution, just like with any other interventions. One of the precautions that clinicians should take is to be mindful of where the client is in therapy and how they will react to the exposure. Before implementing behavioral exposure, it is important to assess whether or not the client is ready for that type of intervention. Furthermore, depending on their progress in therapy, more intense debriefs might need to be had after the exposure is done to ensure that the client is safe. Clinicians should also consider the therapeutic relationship. It is important that there is a strong rapport between the client and clinician before behavioral exposure is started. Behavioral exposure can be very difficult for clients, so it is important that there is a strong relationship and the client can trust the clinician during the difficult time.

    Reply

    • Jennifer Vear
      Nov 04, 2021 @ 11:07:35

      Hi Kaitlyn!

      I really like how you mentioned in the second prompt that the Flow Chart exercises will help Mark to plan outings with friends as well as consider possible scenarios where it could not go according to plan. When preparing for these circumstances, Mark will be able to start implementing the exercise of looking for alternative explanations as to why someone couldn’t go to lunch with him, or canceled last minute, or could not hang out in general. The more he does exercises such as these in various aspects of his life, along with his social life, the better he will be at adapting to new experiences and not allowing a minor setback to have a negative impact on his internal view of himself.
      Overall, great job! This was a really great point that I recognized as well.

      – Jenn

      Reply

    • Giana Faia
      Nov 06, 2021 @ 10:51:20

      Hi Kaitlyn,

      I like how you mentioned how some more historical information could have involved his family’s mental health history and whether or not they have struggled with depression like Mark. This information would be helpful in understanding if he was more prone to depression based on his family’s mental health history. However, like you said, this information could already been identified in an intake and may not be relevant to his current core belief which could be why it wasn’t discussed during this session. Thank you for sharing!

      Giana

      Reply

  4. Katie O'Brien
    Nov 04, 2021 @ 11:43:42

    Core Beliefs – MDD-16

    (1) The flowchart was very helpful for Mark in understanding his core belief and where it came from. It was helpful for Mark to realize when these feelings started coming about, throughout high school, into college, and even a bit at home with the expectations he internalized from his parents. This exercise was helpful in seeing how at those points, the unlikable belief might have had some validity – he did have friends who sort of drifted off for no reason apparent to Mark, leading him to think he, or something about him, was the problem. However, in getting to that core belief, he could begin to see how the situations in his current day to day are somewhat similar, but how the core belief plays out and leads him to cope maladaptively. It started to show him how holding that belief might not be the most helpful at this point in time.

    (2) I wonder, if in addition to these negative experiences throughout high school and college, there were experiences prior to that that had a lasting negative effect on Mark. He mentioned that his parents had high expectations of him – was there ever a point, perhaps even earlier in his childhood, where he felt inadequate in comparison to their expectations, or as if if he did not perform well, they would love him less? I would also wonder if during these times where he felt unlikable throughout highschool and college, there were times when he did feel likable or lovable, say for example, when he started dating Melissa. I think those more positive experiences might be helpful in understanding why the negative experiences had more of an impact on him, while also being potentially helpful when it comes time to modifying new core beliefs.

    Core Beliefs – MDD-17

    (1) I think Mark was able to identify disadvantages of keeping his old core belief of being unlikable, including how it closes him off to forming new relationships or taking the risk of trying new things, and how it trickles down to negatively affect his relationship with Melissa. On the flipside, he can also see how a new core belief would be more helpful in getting him out of the cycle of withdrawal and rumination. In this way, Mark is more motivated to modify a newer, more adaptive core belief.

    (2) I think Mark is able to see that while not every experience goes in the way he hopes, that there is evidence that at least some people do like him, including Melissa. A new core belief might be that in general, Mark is likable to most people. To test this new belief, Mark can try to make plans with existing friends, or ask coworkers to do something simple, such as go for lunch. If these things go well, Mark will have evidence for his new belief. If they do not go as planned, it will be a good exercise for Mark to evaluate possible reasons for them to decline unrelated to his being unlikable. Again, this will provide more practice for Mark to support his new belief and discredit his old one.

    Behavioral Exposure

    (1) Behavioral exposure is very helpful for disorders such as anxiety and PTSD. It allows a client to start facing their anxiety in a safe setting, while learning that they can survive the distress of the anxiety-provoking situation. Usually, those with anxiety disorders will avoid these situations, as they begin to feel those unpleasant physiological and emotional reactions and take them as indicators that they will not be okay. As the therapist is there to help them through it, the client does not feel completely alone in the situation and as they realize they are getting through it, can begin handling even more distressing situations as they know they will not die, etc. Through this process, they are able to begin modifying their thoughts and emotional reactions to the anxiety-provoking stimuli.

    (2) Like any intervention, therapists must be sure that the client is ready for behavioral exposure, and identify how much exposure that particular client can handle at that time of treatment. Throwing a client into too much exposure can be too distressing and leave the client feeling less confident in their ability to handle the situation, rather than more confident. They likely won’t go into another exposure technique, or maybe even return for more therapy if this is the case. Similarly, the therapeutic relationship has to be strong so that the client knows the therapist is doing this to help not harm them, and that they can feel safe with the therapist there as a safeguard when they begin to feel those distressing physiological sensations and emotional reactions. This also includes adequate preparation and debriefing after the exposure, so the client is ready for it and can also process those unpleasant feelings after the fact, in a safe and adaptive way.

    Reply

    • Valerie Graveline
      Nov 04, 2021 @ 15:37:22

      Hi Katie,

      I thought you brought up a good point regarding how it would be helpful for the clinician to learn more about Mark’s experiences with his parents. I think it would be very valuable to delve deeper into his parents’ expectations of him, to see if those expectations were possibly an initiating factor in the development of his core belief “I’m unlikeable” or even maybe “I’m not good enough to be liked”. I also thought you had a very good idea about further exploring Mark’s previous experiences when he did feel liked or loved, whether it be within relationships or friendships. I think that exploring these experiences would be helpful in allowing Mark to further review the evidence that supports a new core belief of “I’m a generally liked person” rather than “I’m unlikeable”.

      Overall, great response!!

      Valerie

      Reply

    • Giana Faia
      Nov 06, 2021 @ 10:57:36

      Hi Katie,

      I like how you mentioned both the advantages and disadvantages of believability of Mark’s core belief and how they impact new or current relationships. By identifying the advantages, he was able to see why he still believes in this current core belief. With the disadvantages, he was able to see why he should not believe his core belief. Like you mentioned, creating a new core belief would be more adaptive and beneficial in creating new relationships as well as manning current relationships. Thanks for sharing!

      Giana

      Reply

  5. Francesca Bellizzi
    Nov 04, 2021 @ 13:05:04

    [Core Beliefs, MDD-16]

    1. The Core Belief Flowchart (A) was highly effective in understanding how Mark’s core belief of being unlikeable/unlovable developed. By working through the flowchart and examining “historical events”, it is relatively easy to see how this particular core belief developed for Mark. Revisiting past experiences was effective in helping Mark understand his core belief as he was able to see how his beliefs from high school and college carried over into his life as it currently is. By reflecting on high school and college years, the client and clinician are able to focus on the first time that Mark believed that he was unlikeable. For example, Mark mentions times during college and high school years where his friends would go hang out without him or “stop talking to him”. This particular situation was the first time that Mark truly believed that he was unlikeable/unlovable due to his friend’s actions. By understanding where the core belief develops from – i.e. the historical event – it is easier for the clinician and client to begin to modify and reconstruct a new core belief.

    2. When completing the core belief flowchart, Mark solely paid attention to events that occurred during his high school and college years. I think this may be due to Mark’s confidence in his ability to “go with the flow, and not fill in the gaps” during this time in his life. All this aside, I think it would be beneficial to also understand and obtain information about family dynamics during this time in his life, yet also during early childhood and adolescent years. As these years greatly influence the development of core beliefs and interpersonal aspects, I believe it would help further the understanding. Moreover, I do wonder if there are events that occurred during this time that may have a significant influence on the development of the core belief that he is unlikeable/unlovable.

    [Core Beliefs, MDD-17]

    1. Examining the evidence and continuing with the core belief flowchart was beneficial in obtaining new information that helped Mark and the clinician develop a new core belief. One thing that was particularly helpful for Mark when trying to develop a new core belief was understanding that there are other variables that may be present that affect the actions of others. For instance, the ideas that they already had plans, didn’t think he would want to go, and most importantly challenging his withdrawal behaviors (shutting off your lights and hiding in your office won’t make them want to ask) were all very influential for Mark. Likewise, pointing out the fact that people do like him (i.e. Melissa) helped Mark come to terms that while he may not be likable 100% of the time, most people like him and in general he is a very likable guy.

    2. The new core belief to test, which is both positive and realistic, is the belief that Mark is generally likable to most people. In order to test his new core belief, Mark should engage in simple behavioral experiments such as asking his friends to make plans (i.e. lunch). These friends should be ones that already exist and/or are coworkers. Evidence for this core belief is exemplified in them saying yes; however, if they decline then this is the perfect opportunity for Mark to start to consider possible alternative explanations that have nothing to do with him.

    [Behavioral Exposure]

    1. Behavioral exposure is very effective for certain disorders/types of distress because it exposes/immerses individuals to things or situations that they tend to fear and avoid in order to break that behavioral pattern. This is particularly effective in those with anxiety disorders (phobias, panic, generalized, social, and obsessive-compulsive), and post-traumatic stress disorder. Due to the fact that individuals with these disorders and types of distress tend to avoid the situations or things that they fear, behavioral exposure is effective because the clinician is there to help them through. Collaboratively, the clinician and client can identify these situations or things, and work through the situation in a safe and supportive environment.

    2. While behavioral exposure is an intervention that is highly effective for particular disorders, it is important to take caution when implementing it. Exposing an individual to a situation or thing that they fear the most can be very stressful for the client. As a clinician, it is important to assess whether this individual is truly ready for this type of intervention as it can cause significant and highly distressing emotional responses. Similarly, it is important to have a plan ready for the client as it is important to know which direction you want to take this intervention as it should be done in a structured manner. Lastly, it is important to assess the therapeutic relationship. If the relationship is one that is not strong, then behavioral exposure could be the last crack in the foundation that makes the whole relationship collapse. However, if the therapeutic relationship is strong, it may be able to withstand behavioral exposure as the client has a high amount of trust and security in the clinician.

    Reply

    • Kaitlyn Tonkin
      Nov 06, 2021 @ 12:24:16

      Hi Francesca,

      I was also wondering what was going on during Mark’s childhood and adolescent years as he really didn’t focus on those years when discussing his history with the therapist. As you said, these years are important in the development of core beliefs, so it would probably be helpful if Mark was able to delve into that part of his history as well. I wonder if there is anything from those years that had an impact on his core belief, especially since he didn’t bring it up.

      Great post!

      -Kaitlyn

      Reply

  6. Lisa Andrianopoulos
    Nov 04, 2021 @ 13:05:22

    MDD-16
    Core beliefs typically develop in childhood or adolescence, and they are based on the interactions one has with significant others and/or those influential in their lives. Significant life events, both positive and traumatic, contribute to further shaping the core belief. In MDD-16, the therapist helps Mark explore these aspects in his own life. Starting with immediate history, then moving back to recent past and then distant past, the therapist was able to help Mark see how the core belief shaped itself over time. Towards the end of the flow chart, Mark also gains some insight about how this particular core belief became prominent in his thinking in the face of significant increased work stress.
    To gain additional historical information, the therapist might have asked about others in his life, besides his parents (within and outside his family) who have had a significant influence on how he thinks. He might also explore any negative messages Mark got about himself as a result of the pressures from his parents.
    MDD-17
    In examining the evidence for Mark’s core belief that he is unlikable, a consistent theme that comes up is that in his recent and distant past, Mark has typically interpreted his friends “blowing him off” as there must be something wrong with him (i.e., he is unlikable) and that they don’t want to spend time with him. His behavioral response is to withdraw/socially isolate. Mark identifies the advantage of this core belief is that it protects him from getting hurt because if he doesn’t get close to people (because he is unlikable) then he won’t get hurt by them. One of the disadvantages he identifies is that it starts a negative cycle that impacts how he interacts with others (Melissa, coworkers) and causes him to withdraw. This validates the need for a new core belief. As he proceeds through the flow chart, Mark is able to state that in actuality, he is a generally likeable person and he is able to give evidence for that (he has good friends and valuable relationships in his life). He further states that the more he says it out loud, the more he believes it. This helps Mark buy in to a new core belief that “I am generally a likable person.” Further, Mark is able to identify many more advantages to this core belief vs. the older one. Mark and his therapist can collaborate using a Behavioral Experiment Worksheet to put together a plan for testing the new core belief between sessions. Using this worksheet they can come up with possible automatic thoughts, maladaptive behaviors or external factors that might influence how he reacts to a friend declining an invitation or cancelling plans. Once these are identified, then they can develop a plan for more adaptive ways to cope with the situation. Mark can then test them out as he encounters the events in real time.

    Behavioral Exposure
    Why is behavioral exposure very effective for certain disorders/types of distress?
    Behavioral exposure is particularly effective for treating anxiety and fear. When an individual experiences significant anxiety and fear, eventually the anxiety and fear develop into maladaptive cognitive and behavioral avoidance patterns because, over time, the avoidance behaviors are reinforced by short-term relief. That is, individuals often cope with anxiety and fear by avoiding situations that make them feel this way. Behavioral exposure is useful here because it gives the client an opportunity to confront the situations they are avoiding. Exposing the client to what makes them anxious helps to break the avoidance pattern.

    (2) What are some cautions to consider when implementing behavioral exposure interventions?
    There are several common challenges that may occur when implementing behavioral exposure interventions. One of the most common is the client’s hesitancy to initiate relaxation and in vivo exposure techniques. Clients may also have difficulty assessing their anxious and fearful patterns.

    Reply

    • Francesca Bellizzi
      Nov 06, 2021 @ 18:57:30

      Hi Lisa,

      Loved your post! I particularly enjoyed when you mentioned that Mark’s core belief that he is unlikeable tends to surface after events in which his friends “blow him off” (or at least this is what he perceives). I think that is a very significant aspect of why his core belief has such a strong foundation and is a key factor in modifying and creating a new core belief that is adaptive.

      Thanks for sharing!

      Francesca

      Reply

  7. Valerie Graveline
    Nov 04, 2021 @ 13:26:51

    (Core Beliefs- MDD-16)
    1) The CBF-A was very effective in helping both the clinician and Mark himself understand how his core beliefs developed throughout his experiences. The different questions within the CBF-A included categories such as significant individuals and events, recent stressors, personal qualities and coping skills, sociocultural factors, and life accomplishments. By going through each of these categories, Mark was able to notice and deeply think about previous experiences that deeply influenced his core beliefs and how he views himself today. For instance, a notable experience that Mark discussed was regarding significant individuals such two of his close friends in highschool and college. With these friends, Mark found that these friendships had drifted away and ended, causing him to feel as though there was something “wrong” with him to where he perceived these individuals to not want to be around him anymore. These events tie directly to Mark’s core belief of “I’m unlikeable”, as he was able to recall specific instances and details with these individuals, showing that he is still deeply affected by the experiences. On the other hand, with the clinician asking questions relating to his life accomplishments, he and Mark were able to explore qualities that Mark likes about himself, which can in turn help him create some new, positive core beliefs later in therapy.

    2) I think additional historical information that could have been obtained in order to understand the development of Mark’s core beliefs would be regarding his previous experiences with significant individuals. Specifically, I think it would be valuable to address his family history, as it is possible that perhaps his parent(s) viewed themselves as unlikeable in a similar manner to Mark, which thus influenced the development of his core belief. Similarly, I think it would be valuable to delve into his previous relationships more, in order to clarify whether this belief of “I’m unlikeable” arose solely from friendships or if it arose within his relationships as well. Currently, from what we have seen in the videos it sounds as though he does not experience this core belief with his current girlfriend Melissa. However, it is possible that such negative experiences occurred during previous relationships.

    (Core Beliefs- MDD-17)
    1) In developing a new core belief, it is helpful to first examine the perceived advantages and disadvantages of the old core belief, and then to compare such information with the advantages of the new core belief. It is important to first examine what the client perceives to be advantages and disadvantages to the old core belief, even if it appears to have no advantages to it. Core beliefs serve some sort of purpose for the individual, so it is crucial to identify what this purpose is as it may be maladaptive for the client. For example, when examining the advantages to the core belief “I’m unlikeable”, Mark identified a purpose of the core belief being that it protects him from getting close to others and ultimately hurt by them. If Mark is unlikeable, then he doesn’t have to worry about getting emotionally hurt by friends as he wouldn’t have any. It also proves very helpful to discuss the disadvantages of the old core belief, so that the client realizes that the negative core belief does more harm to their well-being than it does good. With respect to the new core belief, it is valuable that the client is able to imagine what positive aspects are associated with the new core belief so that they may be more motivated to believe it.

    2) Mark was able to identify a new core belief of “I’m a generally likeable person” in response to the old core belief of “I’m unlikeable”. Aside from this, another possible new core belief that Mark could test with the CBF-B and a behavioral experiment could be “I’m someone that people have enjoyed hanging out with”. I think this core belief relates strongly to Mark’s old core belief where he viewed himself as unlikeable, and someone whom people don’t want to be around. Mark discussed with his clinician that in the past he viewed himself as a “people person”, and would like to continue moving toward feeling confident in this quality again in the future. Mark could test this new core belief with the CBF-B by first examining the evidence to support it, which in this case would be that he was previously a “people person” and has made friends in the past, some of which he still has to this day. Then, he could utilize a behavioral experiment where perhaps he asks a colleague out to lunch that he doesn’t always hang out with. Alternatively, he could reach out to an old friend that he hasn’t seen in a while, and ask to do something with them.

    (Behavioral Exposure)
    1) Behavioral exposure is especially effective for anxiety-related disorders, such as agoraphobia, panic disorder, OCD, PTSD, and social phobia. The type of distress associated with these disorders arises when individuals are anxious, and have negative automatic thoughts that increase their physiological arousal. As a result, these individuals avoid the distressing situation because they perceive it as threatening, which negatively reinforces their thoughts and behaviors. Behavioral exposure allows for the situations that these individuals avoid to be confronted, as this is necessary in order to break the patterns of avoidance. In being exposed to the feared situations, individuals with anxiety-related disorders will learn that the physiological arousal does not last, and ultimately the arousal will decrease over time and over repeated exposures.

    2) Some cautions that clinicians should consider when implementing behavioral exposure interventions include the treatment rationale and goal for the intervention, the client’s type of feared situations, and the clients’ overall needs and readiness to participate in such an intervention. Regarding treatment rationale and the goal for intervention, it is important that the clinician clearly explains the goal of the intervention to the client and how it will guide treatment. Also, it is important that the client is aware of the intervention’s purpose so that they understand why it may be helpful to encounter their feared situation(s). With this said, the clinician should provide sufficient psychoeducation pertaining to the intervention prior to beginning the intervention with the client. With respect to the client’s needs, the clinician should first assess the client’s physiological arousal and levels of anxiety with the feared situation so that they can make an informed decision on which intervention is appropriate to utilize. Once an appropriate intervention is chosen, the clinician should examine whether the client should be accompanied by them during the intervention or if the client is able to practice alone.

    Reply

    • Sergio Rodriguez
      Nov 04, 2021 @ 23:58:07

      Hi Valerie,

      Your post made me think about recent research that mentioned how Behavioral exposure helps individuals with specific phobias or anxiety diagnoses to decrease the physiological arousal after repeated exposures. Usually, those exposures are hierarchical from whatever is easier for the patient to the hardest for them. The article I read mentioned that some of the patients would habituate to the stimulus, and the behavioral progressive exposure won’t help them decrease the distress physiological reaction. In fact, it will just prepare them for whatever was coming in terms of exposure. So the researchers were suggesting that the best way to do it was not progressive or hierarchically, so it was more efficient if the stimuli were presented in random order.

      Thanks for sharing!
      Sergio R.

      Reply

  8. Morgan Rafferty
    Nov 04, 2021 @ 14:24:09

    Core Beliefs
    1.)
    The CBF-A was effective in understanding how Mark’s core belief developed. In the session Mark revisited an experience that happened in 10th grade. Mark’s friend Dave started distancing himself from Mark. Specifically, Dave did not seem to want Mark to come watch him play in his deck hockey game. This led Mark to questioning his own likeability. Mark remembers not being very popular in high school and feeling a little depressed.
    Mark’s parents were divorced. They had high expectations of Mark and this might be why he currently questions whether he is doing a good enough job at work. Mark also recounts how in college his freshman year roommate, Brian, played video games instead of joining Mark for the dining hall. Brian drifted away from Mark. These things led Mark to question, “does he even want me around?”
    It was helpful in guiding Mark to remembering these past events as a way to understand how his core belief: “I am unlikeable” developed.
    2.)
    Additional historical information could have been gathered to further understand the development of Mark’s core belief. It would be interested to explore the divorce of his parents; how old was Mark? How did he react? Does Mark have any siblings? What birth order is Mark and how was his relationship with his siblings during childhood? And current day? How about extended family: grandparents, aunts, uncles, cousins? It might be helpful to explore other relationships in his life and determine if they contributed to the development of Mark’s core belief. Also, do those relationships support his core belief of being unlikeable or provide evidence against his core belief?

    Behavioral Exposure
    1.)
    Behavioral exposure helps relieve anxiety-related distress and helps cope with related life stressors. It is effective in treating agoraphobia, obsessive-compulsive disorder, panic disorder, PTSD and social phobia. Behavioral exposure has the opposite effect of avoidance. It operates on the principle of “face your fears”. It is performed in a safe environment. It is effective because individuals eventually cognitively learn after repeated exposures to their source of anxiety that the content/situation is no longer threatening. Work can then be done on modifying their negative automatic thoughts. They also develop associated behavioral and coping skills to manage possible future distress. New automatic thoughts such as “I can do this”; “It’s not a big deal” replace former negative ones.

    2.)
    Some cautions to consider when implementing behavioral exposure interventions are that the initial result is an increase in anxiety and fear. This physiological arousal will not last forever and will eventually decrease over time after successful repeated exposures. It is important that the therapist be aware of this when implementing behavioral exposure interventions. The therapeutic relationship must be strong and built on trust. The therapist needs to be attuned to his/her client and assess whether he/she is ready for exposure and to what degree. It is often best if the exposure begins at small levels and is gradually increased over time.

    Reply

    • Valerie Graveline
      Nov 04, 2021 @ 15:44:10

      Hi Morgan,

      I thought you did a very nice job of explaining the process of behavioral exposure and its importance as an intervention. I think it is super important to highlight your point that behavioral exposure is always completed in a safe environment, as this will help the client understand that they are not truly in danger when this intervention is utilized. With this, I think a good point brought up in Chapter 9 was that psychoeducation with the client is especially crucial for an intervention like this. It is important that the clinician clearly explains the rationale for behavioral exposure, as well as the process of the intervention so to somewhat ease the nerves of the client as they are already being faced with situations they fear most.

      Valerie

      Reply

  9. Morgan Rafferty
    Nov 04, 2021 @ 14:37:01

    Core beliefs
    1.)
    The information obtained that will be helpful in developing a new core belief is:
    *Melissa likes Mark
    *colleagues at work do indeed demonstrate behaviors suggesting they like Mark; in his words: “They hired me”.
    2.)
    A new, realistic, positive core belief for Mark could be: I am generally likeable. Mark does believe he is a good guy and that he has good people in his life. Mark acknowledges an advantage of his negative core belief of unlikeability might have been preventing him from getting very close to people and therefore as a result protecting him from getting hurt.

    Reply

  10. Giana Faia
    Nov 04, 2021 @ 14:56:17

    [Core Beliefs]

    (1) The CBF-A is helpful for understanding negative core beliefs because it focuses on a personal client-specific example. The CBF-A illustrates how patterns of thinking, feeling, and behaving are created from a negative core belief. For Mark, he was able to visualize the event, the automatic thought along with that event, the emotions he felt, and the behaviors he engaged in following the event. Once this was mapped out, Mark was ask questions to help him identify where his core beliefs may stem from. Mark identified a past experience from high school that related to his core belief, demonstrating how deeply ingrained this core belief was. This also helped Mark recognize patterns that relate to his core belief which was effective in recognizing patterns that maybe led to the development of the core belief.

    (2) Mark discussed his high school and college experiences, friendships, and was asked about major experiences. I think some additional historical information that could have been obtained would be relating more to his home life. He did mention that he was an only child but I wonder if his childhood/ home life was explored more that something relevant would be uncovered. I wonder if there were patterns similar to his current ones that were experienced that ingrained this core belief even before high school/ college.

    [Core Beliefs]

    (1) From both techniques, examining the evidence that supports the core belief is helpful because it can help in identifying the patterns that reinforce the core belief. Similarly, this information is important and can be used to reframe the “old evidence” that supports the negative core belief. By examining the evidence, Mark was able to realize that people do like him and he does have friends that like him. Along with this, identifying evidence that is again the core belief is also beneficial for comparison. Mark also identified both advantages and disadvantages for both the negative and more positive/ realistic core belief which is helpful.

    (2) Mark identified a new core belief as “I’m generally a likable person” which would be a more positive/ realistic core belief. Mark was able to reach this new core belief after pointing out that not everyone hates him but not everyone likes him, as he said. A Behavioral Experiment that Mark could attempt would be inviting his girlfriend and some of his coworkers to luck or dinner. By inviting Melissa, at least he will have one person there in event that a coworker can’t make it.

     
    [Behavioral Exposure]

    (1) Behavioral exposure is very effective for anxiety/ anxiety-related disorders. Behavioral exposure is used to confront certain situations that are usually avoided. It is used to break the avoidance pattern so that clients are face with what is causing them anxiety. Exposure is effective because overtime it will reduce the physiological arousal after repeated successful exposure. This helps clients learn overtime that the situation is no longer threatening. With this, they also develop coping skills that help them better manage distress moving forward.

    (2) When implementing behavioral exposure interventions, there are some common challenges. First, clients often struggle with assessing anxious and fearful patterns. This relates to narrowing down the focus on the negative automatic thoughts. Next, clients are usually hesitant to begin progressive muscle relaxation and or diaphragm breathing. This might be off-putting to clients because they believe it to be silly or don’t think it will work. Clients can also be hesitant to start in vivid exposure techniques. Here, it is important to reassure the client by providing the rationale and method. You also want to be mindful of the client and start by taking small steps.

    Reply

    • Lindsay O'Meara
      Nov 06, 2021 @ 18:43:55

      Hi Giana,

      It was really interesting to hear Mark’s memories of past friendships. His childhood and home life would be interesting to explore a little deeper. I wonder if he has siblings, or if his parents ever made him feel rejected. There may be patterns from childhood that he didn’t mention as well. Examining new evidence of being cared about by his friends will definitely assist in restructuring to a positive core belief in the future.

      Thanks,
      Lindsay

      Reply

    • Francesca Bellizzi
      Nov 06, 2021 @ 18:51:36

      Hi Giana,

      Great post! When I thought about getting information about Mark’s home life as a child, I only discussed parental dynamics. I really like your idea about getting information about how he was an only child may have affected this as well. I honestly completely missed that comment while watching the video, so great catch!!

      Thanks for sharing (:

      Francesca

      Reply

  11. Lindsay O'Meara
    Nov 04, 2021 @ 15:21:56

    [Core Beliefs] – MDD 16

    1. The core belief flow chart was effective in understanding how the clients’ core belief developed because it helped us gain insight into events that had made him feel unlikeable in the past. We found that Mark’s category of core belief in this situation is unloveable and that his lens was himself. We also learned that in adolescence, Mark lost a friendship and had feelings that he was unlikeable. He was also left out by friends while others were invited, which made him think that maybe something was wrong with him. Mark ended up having more friends who didn’t seem to want to spend time with him, including his freshman year roommate in college. Mark felt worried and felt like maybe it was because he was unpopular. We found that Mark has always tended to put distance between himself and the situations that are stressful for him. Mark’s parents had high expectations for him, which might have led to another core belief.
    Asking questions about the clients’ history helps both the client and the therapist to figure out what people or events may have contributed to their core belief. Breaking down the significant individuals, life events, coping skills, and various other topics can help to really get to the bottom of where the core belief came from. Once you are both able to see what events led the client to where they are, you can begin to modify the negative core belief.

    2. To understand the development of the clients’ core belief, you could dive deeper into certain areas. In this case, many of Mark’s past friendships resulted in the same pattern, so is helpful to recognize that. I think it would be interesting to find out what Mark’s past romantic relationships were like. There might be factors in those relationships that have contributed to his feelings of being unlikeable as well.

    [Core Beliefs] – MDD 17

    1. Finding evidence for new core beliefs can help to modify an old negative core belief. A theme that developed was that Mark feels blown off by his friends often. He also felt as though Melissa may not have loved him for a long period of their relationship. I think that by realizing that he has had these feelings throughout his life, helped Mark to see that he does have a negative core belief of unloveable. By reinterpreting some of the events in Mark’s life, he was able to realize that his friends are not always blowing him off. His long-term relationship with Melissa has helped him to recognize that she isn’t going anywhere and does like being with him. Using the evidence that he has gained will help him to modify his thinking and move towards a new core belief.

    2. A new core belief that would be helpful to test would be something like; “People do like me around most of the time.” Or; “I am likeable most of the time.” These are realistic because not everyone is likeable all of the time. Saying something like; “Everyone loves me.” Would not be a realistic thought because it’s not possible. He came up with “I am a generally liked person,” which is important for Mark. He plans to put himself out there and try to spend more time with friends. By thinking that he is somewhat likeable, he can feel better about himself and hopefully build confidence to reach out to his friends more often.

    [Behavioral Exposure]

    1. Behavioral exposure can help with anxiety-related disorders, but it can also help with issues such as difficulty relaxing, poor coping, and poor social skills. When dealing with negative automatic thoughts, avoidance can only go so far. With behavioral exposure, we combat avoidance with confrontation. Exposure techniques help to break behavioral avoidance patterns. When a client is exposed to their fears, they are assisted by their therapist so that they feel safe. With a safe environment and support, behaviors and thoughts can be modified.

    2. It is very important to make sure that the client is ready for exposure. If a client is not in a good place to start this intervention it can be stressful for them. The clients’ safety both physically and mentally are extremely important to consider. The client and therapist must also have a strong relationship so that the client is able to feel safe when confronting their fears.

    Reply

    • Sergio Rodriguez
      Nov 04, 2021 @ 23:38:34

      Hi Lindsay,

      I definitely agree with you. Analyzing some of Mark’s previous relationships will provide some ideas that reflect some patterns of his interactions. He mentioned that his previous friendships followed a pattern when his friends stopped hanging out with him as much as they did before, which is one of his biggest fears every time he had a difficult time or an interaction that provided a sense of insecurity with his friends and he felt unlikable. Likewise, I didn’t think knowing about Mark’s past romantic relationships and how they probably affected his actual interactions. I would like to know how other relationships develop and also how he felt through all the dating process.

      Thanks,
      Sergio R.

      Reply

    • Katie O'Brien
      Nov 05, 2021 @ 19:56:20

      Lindsay,

      Good point about delving deeper into Mark’s past romantic experiences! I’ve found it interesting throughout watching Mark that he doesn’t seem to have that ambiguity or insecurity regarding his relationship with Melissa. It seems to be more in regard to his friendships and work relationships that he has doubts about being liked. I wonder if he has better past experiences romantically, or if they fit the theme as his past friendships. I’d like to know more about how his relationship with Melissa started and if he ever had these questions about their relationship / his likability with her.

      Great response!

      Katie

      Reply

    • Frayah Wilkey
      Nov 06, 2021 @ 19:51:36

      Lindsay,
      I think you brought up a lot of great points about how Mark analyzed his core beliefs and past experiences. I also liked your response to the possible modifications to those beliefs. You brought up a really important point about how the core belief should be realistic. In this case “unloveable” shouldn’t be modified into “everyone loves me” because that’s just not realistic and would set Mark up for failure. Great responses to each question!

      Reply

  12. Sergio Rodriguez
    Nov 04, 2021 @ 16:03:43

    [Core Beliefs]
    MDD-16:
    (1)
    The CBF-A was effective for Mark’s understanding of how his core belief was built-up, analyzing multiple factors that contributed to this specific outcome and current belief. The main advantage of this format is that it helps avoid omitting details that might otherwise be overlooked. It was essential to highlight crucial elements and remember specific situations with people in high school. He was identifying some of the roots about certain beliefs or questions of why he may feel unlikeable. Likewise, it happened with his parents’ expectations of him and other elements that helped him step back and think about something. Similarly, Mark recognized how he previously responded to these types of sensations, e.g., withdrawing or playing video games.
    I consider as an important element the fact that some of his friends that he felt very close changed their group of friends, generating him questions about whether they really wanted him around and also how a friend who may be seemingly said to be a friend may change most likely because Mark wasn’t enough or his friend’s new group didn’t want him around.
    (2) I believe that during the session the therapist went through with Mark using the CBF-A, he covered a large part of the patient’s situations in his life, which could have generated this type of core belief.
    However, perhaps the family setting was not as well explored by the therapist. Possibly understanding a little more of his history could have helped more understanding how his background was affecting his current situation. In this sense, another interesting element could have been exploring the academic and work-related accomplishments in greater depth. In this way, it would be possible to analyze how certain expectations and frustrations can contribute to developing his core beliefs.

    [Core Beliefs]
    MDD-17:
    (1) One of the most important tools for the development of a core belief is that it is possible to identify the two opposite poles of the beliefs, that is, how starting from elements such as lens: self, others, world, and significant events it is possible to make a deep analysis of the core beliefs and in turn counter it with evidence, the advantages of a new core belief. The latter is fundamental given that on many occasions, the permanence and rootedness of core beliefs lie in the fact that they become the safe places of immovable and unquestionable beliefs about how the world “works” or “should work”. In this sense, finding in the new core beliefs a middle ground, where Mark does not fall into any pole of irrational beliefs such as: everyone should love me, or they do not love me because I am not enough, could be better understood in terms of it is okay if there are people who do not love me or do not like me. Hence, acceptance can be evaluated in terms of a pattern behavior that can be linked to events that occurred in the past but can be moldable in the present, such as the concept of self-efficacy and accompaniments and how these can help to obtain a new core belief.

    (2) A new “positive”/realistic core belief that Mark can work I am worthy; I am worthwhile. One of the patient’s biggest insecurities is that he was probably not likable to many people he once considered necessary in his life. The first step is to check the evidence that there are people who love and value him for who he is, such as his partner, his friend, his family, among others. Once this is established, it is also possible to consider that there may be people who do not like him or people for whom he is not likable. This means that even though there may be people he is not likable, he is still worthy of being liked. Consequently, if the patient considers that he is worthwhile, it is much more likely that when situations such as those that have occurred in the past where he has felt rejection by someone close to him, instead of withdrawing and feeling unloved, he will be more likely to be loved. For instance, instead of withdrawing and feeling unlovable and withdraw, he may approach the person and express his feelings and perhaps ask assertively (skill to develop) what were the variables or reasons why certain interactions did not occur; such as the case of his friend who invited him home for dinner and cancelled at the last minute or his colleague at work who replied that he did not want to have lunch with him but later told him some other time. Having a new core belief that the patient is worthwhile will be essential to undertake another series of actions that will allow him to have a better posture in the face of adverse situations that may arise with the important people in his life and in the long term to have the tools to reduce his emotional discomfort.

    [Behavioral Exposure]
    (1) Behavioral exposure is very effective for specific disorders like anxiety because, broadly speaking, individuals with anxiety avoid the source of distress, because the distress they are feeling is gone and they feel safe and immediate emotional relief (negative reinforcement). The problem with this short-term relief is that it does not help individuals cope with that stressful situation in a long-term period. The behavioral exposure confronts the client to break the avoidance pattern and expose the individuals to whatever stimuli makes them feel anxious to cognitively learn that the situation is no longer a threat.

    (2) Exposure techniques are idiosyncratic depending on the anxiety disorder. Thus, most of them are used, and they can be used progressively according to the diagnosis and the patient. For example, behavioral exposure can be done: In vivo or Imaginal. One important element is the physiological activation that goes with the psychological distress, “it is impossible to drive a car if you are pressing the gas and the brake pedals at the same time”. Then, the first step will always be deep breathing and muscle relaxation, later the client will learn how to recognize when his brain is eliciting “alert” responses to his body even though the situation is still safe. That being said, there are other particular techniques like analyzing automatic thoughts and the behavioral automatic response.

    Reply

    • Katie O'Brien
      Nov 05, 2021 @ 20:00:20

      Sergio,

      I think it’s good to point out that while Mark’s new core belief might be that he is generally likable, there may still be people down the line who do not particularly like him. Hopefully following therapy and the modification of his core belief, he will be able to take this in stride and think “they might not like me, but I’m general, other people still do,” instead of withdrawing, ruminating and generalizing to all his other relationships. Like we talked about in class, I’d be interested to learn Mark’s reaction to interacting someone who truly doesn’t like him. Given where he’s at, it seems he might not take it quite as hard.

      Nice point!

      Katie

      Reply

    • Lindsay O'Meara
      Nov 06, 2021 @ 18:10:53

      Hi Sergio!

      I think that “I am worthy” would be a good new core belief for Mark. It is apparent that he does not find himself worthy of being liked or invited places so I think that would work! Assertiveness rather than withdrawal is definitely something positive that Mark could work on. The evidence that Mark has compiled towards his new belief will hopefully give him the confidence to be more direct.

      Thanks,
      Lindsay

      Reply

    • Frayah Wilkey
      Nov 06, 2021 @ 19:48:06

      Sergio,
      I think you did a great job in explaining the CBF-A. I also like how you went through Mark’s past experiences and detailed why that are so important to his current feelings of distress. I also agree that his family history may be important to look into more to see if those relationships played more of a role in the development of his core beliefs. Good job overall!

      Frayah

      Reply

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Adam M. Volungis, PhD, LMHC

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